Discrepancies in measuring bladder volumes with bedside ultrasound and bladder scanning in the intensive care unit: A pilot study

Objective Intensive care unit patients are at risk for catheter-associated urinary tract infection. Earlier removal of catheters may be possible with accurate measurement of bladder volume. The purpose was to compare measured bladder volumes with bedside ultrasound, bladder scanner, and urine volume. Design Prospective correlational descriptive study. Setting Surgical/trauma intensive care unit and medical intensive care unit. Patients Renal dialysis patients with less than 100 ml of urine in 24 h prior to urinary catheter removal and patients with suspected catheter obstruction. Measurements and main results A physician trained in ultrasound and an advanced practice registered nurse trained in bladder scanning measured bladder volume; each blinded to the other’s measurement. Device used first (ultrasound or bladder scanner) alternated daily. The intensive care unit team determined need for intermittent catheterization or treatment for suspected obstruction. Fifty-one measurements from 13 patients were obtained with results reported in milliliters. Ultrasound measurements were a mean volume of 72.1 ± 127 (range: 1.7–666) and the bladder scanner measurements were 117 ± 131 (0–529). On six occasions in five dialysis patients, urine volume measurement was available. The mean difference in ultrasound–urine volume mean difference was 0.5 ± 37.8 (range: −68 to 38.2) and the bladder scanner–urine volume was 132 ± 167 (−72 to 397). Two patients with suspected catheter obstructions had ultrasound, bladder scanner, urine volume measurements, respectively: (1) 539, 51, >300 (began voiding before catheter replaced); (2) 666, 68, 1000 with catheter replacement. Conditions leading to greatest differences were obesity, indwelling catheter and ascites. Conclusions These results demonstrate the inaccuracy of the bladder scanner. Ultrasound measurements appear more accurate. To remove urinary catheters in patients with minimal to low urine output, serial ultrasound measurements can be used to monitor bladder volumes and return of renal function.

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Patient-Reported Outcomes Associated With Sedation and Agitation Intensity in the Critically Ill

American Journal of Critical Care ◽

10.4037/ajcc2020592 ◽

2020 ◽

Vol 29 (2) ◽

pp. 140-144

Author(s):

Ashleigh Malinowski ◽

Neal J. Benedict ◽

Meng-Ni Ho ◽

Levent Kirisci ◽

Sandra L. Kane-Gill

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Patient Reported Outcomes ◽

Surgical Trauma ◽

Related Factors ◽

Patient Reported ◽

Sedation And Analgesia ◽

Patients Experience

Background Patient-reported outcomes are essential to understand the relationship between patients’ perception of sedation and clinicians’ assessments of sedation. Objectives To evaluate the association between sedation and agitation indexes and patient-reported outcomes of sedation and analgesia. Methods This prospective, single-center, observational study included adult patients who were continuously sedated for at least 24 hours in a medical or surgical/ trauma intensive care unit. Patients were interviewed after sedation was discontinued regarding their satisfaction with the quality of sedation and potentially related factors. The primary outcome was the correlation between sedation and agitation indexes and patient-reported outcomes. Results A total of 68 patients were interviewed after sedation. Of these, 29 (42.6%) described their overall feelings about their experience while receiving mechanical ventilation in the intensive care unit as "pleasant". When asked about their desires if they were to experience the situation again, 29 patients (42.6%) reported that they would want more sedation. Agitation index was statistically significantly correlated with several patient-reported outcomes. Receiving mechanical ventilation (r = 0.41, P = .002), the amount of noise (r = 0.34, P = .01), suctioning (r = 0.32, P = .02), difficulty resting or sleeping (r = 0.39, P = .003), inability to communicate by talking (r = 0.36, P = .008), anxiety (r = 0.29, P = .03), panic (r = 0.3, P = .02), and frustration (r = 0.47, P < .001) were associated with a higher agitation index. Conclusion Agitation index was significantly associated with several patient-reported outcomes and thus seems to be a promising descriptor of patients’ experience.

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Sonographic Assessment of Intravascular Fluid Estimate (SAFE) Score by Using Bedside Ultrasound in the Intensive Care Unit

Critical Care Research and Practice ◽

10.1155/2020/9719751 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Keith Killu ◽

Victor Coba ◽

Dionne Blyden ◽

Semeret Munie ◽

Darlene Dereczyk ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Scoring System ◽

Venous Pressure ◽

Tertiary Care ◽

Bedside Ultrasound ◽

Volume Status ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Volume Score

Objective. The objective of the study was to use an ultrasound-based numerical scoring system for assessment of intravascular fluid estimate (SAFE) and test its validity. Methods. A prospective, observational study was carried out in the surgical intensive care unit (ICU) of an urban tertiary care teaching hospital. Patient’s intravascular volume status was assessed using the standard methods of heart rate, blood pressure, central venous pressure, cardiac output, lactate and saturation of venous oxygen, and others. This was compared with assessment using bedside ultrasound evaluation of the cardiac function, inferior vena cava, lungs, and the internal jugular vein. Applying a numerical scoring system was evaluated by Fisher’s exact testing and multinomial logistic model to predict the volume status based on ultrasound scores and the classification accuracy. Results. 61 patients in the ICU were evaluated. 21 (34.4% of total) patients diagnosed with hypovolemia, and their ultrasound volume score was −4 in 14 (66.7%) patients, −3 in 5 (23.8%) patients, and 0 in 2 (9.5%) patients (p<0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and −1 in 1 (5.6%) patient (p<0.001). 22 (36.1% of total) patients diagnosed with hypervolemia, and their ultrasound volume score was +4 in 4 (18.2%) patients, +3 in 15 (68.2%) patients, and + 1 in 1 (4.6%) patient (p<0.001). We found a strong association between standard measures and the ultrasound score (p<0.001). Conclusion. Using the SAFE scoring system to identify the IVV status in critically ill patients significantly correlates with the standard measures. A SAFE score of −4 to −2 more likely represents hypovolemia, −1 to +1 more likely represents euvolemia, and +2 to +4 more likely to be hypervolemia.

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Endotracheal Tube Position Confirmation by the Bedside Ultrasound in Respiratory Intensive Care Unit Patients

CHEST Journal ◽

10.1016/j.chest.2016.02.181 ◽

2016 ◽

Vol 149 (4) ◽

pp. A175

Author(s):

Wei Lei ◽

Fenglin Dong ◽

Jiajia Wang ◽

Yehan Zhu ◽

Jian'an Huang

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Endotracheal Tube ◽

Bedside Ultrasound ◽

Tube Position ◽

Respiratory Intensive Care Unit

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Outcomes for dialysis patients with end‐stage renal failure admitted to an intensive care unit or high dependency unit

The Medical Journal of Australia ◽

10.5694/j.1326-5377.2008.tb01624.x ◽

2008 ◽

Vol 188 (5) ◽

pp. 292-295 ◽

Cited By ~ 20

Author(s):

Sivagnanavel Senthuran ◽

Hiran Bandeshe ◽

Dwarakanathan Ranganathan ◽

Robert Boots

Keyword(s):

Intensive Care Unit ◽

Renal Failure ◽

Intensive Care ◽

High Dependency Unit ◽

Dialysis Patients ◽

End Stage Renal Failure ◽

High Dependency ◽

End Stage

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Can the blood gas analyser results be believed? A prospective multicentre study comparing haemoglobin, sodium and potassium measurements by blood gas analysers and laboratory auto-analysers

Anaesthesia and Intensive Care ◽

10.1177/0310057x19840046 ◽

2019 ◽

Vol 47 (2) ◽

pp. 120-127 ◽

Cited By ~ 2

Author(s):

Katherine E Triplett ◽

Bradley A Wibrow ◽

Richard Norman ◽

Dana A Hince ◽

Liesel E Hardy ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Point Of Care ◽

Mean Difference ◽

Full Blood Count ◽

Blood Gas ◽

Prospective Multicentre Study ◽

Significant Difference ◽

The Mean ◽

Sodium And Potassium

Blood gas analysers are point-of-care testing devices used in the management of critically ill patients. Controversy remains over the agreement between the results obtained from blood gas analysers and laboratory auto-analysers for haematological and biochemistry parameters. We conducted a prospective analytical observational study in five intensive care units in Western Australia, in patients who had a full blood count (FBC), urea, electrolytes and creatinine (UEC), and a blood gas performed within 1 h of each other during the first 24 h of their intensive care unit admission. The main outcome measure was to determine the agreement in haemoglobin, sodium, and potassium results between laboratory haematology and biochemistry auto-analysers and blood gas analysers. A total of 219 paired tests were available for haemoglobin and sodium, and 215 for potassium. There was no statistically significant difference between the results of the blood gas and laboratory auto-analysers for haemoglobin (mean difference –0.35 g/L, 95% confidence interval (CI) –1.20 to 0.51, P = 0.425). Although the mean differences between the two methods were statistically significant for sodium (mean difference 1.49 mmol/L, 95% CI 1.23–1.76, P < 0.0001) and potassium (mean difference 0.19 mmol/L, 95% CI 0.15–0.24, P < 0.0001), the mean biases on the Bland–Altman plots were small and independent of the magnitude of the measurements. The two methods of measurement for haemoglobin, sodium and potassium agreed with each other under most clinical situations when their values were within or close to normal range suggesting that routine concurrent blood gas and formal laboratory testing for haemoglobin, sodium and potassium concentrations in the intensive care unit is unwarranted.

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